Direct thrombin inhibitors
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- binds to thrombin directly at its active site
- inhibition of thrombin results in an anticoagulant effect
- Postsurgical VTE prophylaxis
- Severe heparin-induced thrombocytopenia (HIT)
- CI: pts at high risk for bleeding
- SE: bleeding
Dabigatran indication & dose:
- Prevention of stoke and systemic embolism in patients with A-fib
- 150mg po BID- on exam
Argatroban indication & dose:
- Anticoagulation in patients with A-fib
- Initial dose: 2 mcg/kg/min IV
- Maintenance: adjust dose until the steady-state aPTT is 1.5-3 times the initial baseline value
what is the advantage of direct over indirect thrombin inhibitors (LMWHs)?
they provide more predictable anticoagulation
how do you monitor the anticoagulation of bivalirudin and argatroban?
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